Posts Tagged ‘Stress History’

Causes of psychophysiologic disorder (PPD) symptoms are so diverse that even after assessing thousands of patients I still encounter new variations. Earlier this year a 65 year old retired nurse practitioner from Oregon whom I have worked with in the past contacted me because of months of abdominal pain. She suspected PPD because medical evaluation was unrevealing and her symptoms fluctuated for no obvious reason.

A colleague asked how I would screen for Adverse Childhood Experiences (ACEs) in primary care patients with unexplained illness, chronic pain or functional syndromes such as irritable bowel or fibromyalgia. (A blog of mine describing ACEs is here with an important web site here). Here is my answer:

Continuing from the last post, recall that in my practice a large majority of over 7000 patients with medically unexplained symptoms were referred due to failure to grasp the their psychosocial issues.

I’m not the neatest person. My love of learning leads me to hang on to more printed material than I have time to read. This causes clutter. Every so often I clean up the piles and yesterday was such a time. I came across an email from last year that, unusually, I had printed.

One of the most frequent requests I receive is for a way to screen for the presence of hidden stresses. Most of those who inquire are interested in administering a questionnaire to patients/clients as they wait to see their clinician. No suitably brief, scientifically validated questionnaire exists that covers the full range of hidden stresses but I have created a reasonable question set and added it to the Book Overview section of this site.

Remarkably, mental health practitioners (MHP) are largely uninvolved with the largest single group of people with mental health issues. This is because those issues are manifesting most prominently as physical symptoms. These patients find it difficult to imagine that their illness is stress-related. They seek help from medical clinicians, few of whom have formal training in stress illness diagnosis and so usually don’t refer to MHPs. Even when patients are referred, few MHPs have much experience with what to look for in a patient complaining of physical symptoms. It is uncommon for MHPs to know that they can relieve these symptoms using their usual techniques augmented by a Stress History.

The search continues for a valid, ultra-short screening questionnaire for stresses capable of causing physical illness. Once that is in place, the next step is for primary care clinicians to learn how to further evaluate a patient with a positive screen. This should then lead to systems for follow-up care and monitoring, including the option of referral to mental health clinicians experienced with patients who have physical symptoms.

In the last post we saw four questions (PHQ – 4) that screen for anxiety and depression. These are described in the reference below (1). However, to document that screening questions achieve their intended goals and are scientifically valid, it is not enough merely to come up with what sound like reasonable questions.

One of the most frequent questions I get after my talks to medical clinicians is about rapid ways to screen for sources of stress. A validated questionnaire that revealed stress issues prior to the patient being seen would, theoretically, enable more accurate diagnosis in less time.